Effective daily treatment with clomipramine in men with premature ejaculation when 25 mg (as required) is ineffective

Objective. To determine whether men with premature ejaculation who fail to respond to 25 mg clomipramine as needed improve when taking 10-30 mg clomipramine daily. Subjects and methods Four men with premature ejaculation whose ejaculation latencies increased minimally or not at all when taking 25 mg clomipramine as needed participated in a prospective 12-week study consisting of four treatment phases, beginning with baseline (0 mg) and progressing through increasing daily doses of 10, 20, and 30 mg clomipramine. The subjects maintained daily logs of their sexual activities and estimated their ejaculatory response, sexual arousal and penile rigidity during intercourse. The subjects were contacted 8-15 weeks after the experiment to assess their satisfaction with and continued use of clomipramine. Results There was a dose-response effect on ejaculatory latency with increasing levels of clomipramine; 30 mg increased the latency from 25 s to 220 s, a clinically significant increase. In addition, 30 mg taken daily was significantly more effective than 25 mg as required. Other variables of sexual response (sexual interest, arousal and penile rigidity) were unaffected. At follow-up all four subjects expressed satisfaction and three continued the dose. Conclusion Men with premature ejaculation who do not respond to clomipramine 'as required' are probably not insensitive to pharmacological treatment, but may simply require higher doses or a different regimen. All four subjects improved when taking daily clomipramine at varying doses. These results suggest that if initial treatment is unsuccessful, 20-30 mg daily clomipramine should be considered.